oral med Flashcards
Common deficiencies causing angular chelitis:
Often presents with an associated candidal / staph infection.
- iron deficiency
- B12 deficiency
- folate deficiency
A 50 year old man presents with multiple crusting lesions and ulcers on the LHS of his face. He noticed a tingling sensation beforehand and the rash has been present for a week.
Which virus is the potential cause?
Herpes Zoster - shingles
- herpes zoster comes from the varicella zoster virus which also causes chickenpox.
- not the same as herpes simplex but can be treated the same.
Which virus is associated with the development of hairy leukoplakia?
epstein barr virus
Which form of candidal infection has a risk of becoming malignant?
chronic hyperplastic candidiasis
Target lesions are commonly seen in which type of condition?
erythema multiforme
combined with oral lesions and eye problems - type 3 sensitivity reaction in response to medications.
(not the same as steven’s-johnson syndrome)
Features of Minor RAS
- occurs on non-keratinised mucosa
- present in the front of the mouth
- lasts up to 2 weeks
- heal without scarring
- up to 1cm in size
Shillings Test can be done to identify which deficiency?
B12
A 14 year old presents with bilateral, painful enlargement of the parotid gland.
What is the likely diagnosis?
mumps
Kaposi’s Sarcoma is associated with which virus?
HHV8
Common characteristics of trigeminal neuralgia?
- brief stabbing pain
- unilateral
- mandibular branch most commonly impacted
What is the first line drug of choice for trigeminal neuralgia?
carbamazepine - (sodium channel blocker)
Which blood tests should be carried out to monitor carbamazepine?
liver function tests
What would be a potential complication of temporal arteritis if left untreated?
blindness
Squamous cell papilloma’s are commonly caused by which virus?
HPV
Syphilis is commonly caused by which bacteria?
treponema pallidum
What would be prescribed to a pt suffering from shingles?
aciclovir
A 20 year old man presents with a buccal swelling associated with his partially erupted wisdom tooth.
Which type of cyst is this most likely to be?
paradental cyst
What is another name for mumps?
acute sialadenitis
Which medication can cause a black tongue?
heartburn / indigestion meds (pepto-bismol)
What is a white/grey lesions that disappears on stretching?
leukoedema
What is the therapeutic range for warfarin?
3-3.5
What are sublingual varicosites / varices?
Superficial veins on the ventral tongue - increased prevalence with age.
What are fordyce spots and where are they found?
Ectopic / superficial sebaceous glands on commissure.
Multiple yellow coloured granules.
What are fimbrae plicate?
Fabricated fold of tongue that runs either side of lingual frenulum - normal residual tissue.
What are tori and where are they usually found?
Bony exostosis that slowly grow.
Found on the midline of hard palate OR lingual surface of the mandible.
When can the presence of tori become an issue?
When dentures are required.
What is linea alba?
A white line on the buccal mucosa - area of keratosis due to occlusion.
What is leukoplakia and what causes it?
White patches of questionable risk that carry no increased risk of cancer.
What is erythroleukoplakia?
HIGH RISK LESION
Red, velvety plaque that cannot be characterised as any other recognisable condition.
What is speckled leukoplakia?
syn = erythroleukoplakia
(mixed lesion, HIGH RISK)
Outline the differences between the 2 types of blister.
vesicle - small blister (<5mm)
bulla - large blister (<5mm)
What is a vesicle?
Small blister - <5mm
What is a bulla?
Large blister - >5mm
A white patch / plaque of questionable risk having excluded other known diseases or disorders that carry no increased risk of cancer.
Leukoplakia
A bright red, velvety plaque that cannot be characterised clinically / pathologically as any other recognisable condition.
Erythroleukoplakia
The thinning of surface epithelium without any exposure of the underlying connective tissue.
Atrophy
Complete loss of surface epithelium of underlying connective tissue.
Ulcer
Destruction of hesmidomes and separation of epithelium and connective tissue leading to subepithelial blisters showing splitting at the basement membrane.
a - which condition
b - which antibodies are present in the basement membranes of this condition
c - scarring of this condition can lead to…
a - mucous membrane pemphigoid
b - C3 and IgG
c - blindness
A patient with an immunobullous disorder presents with intra-oral vesicles that rupture easily, fishnet appearance under DI, destroys DSG 1+3 using autoantibodies.
What disease do they have?
pemphigus vulgaris
What is the name of the giant cells that can be detected in pemphigus vulgaris as well as herpes simplex and varicella zoster viruses?
tzanck cells
Which steroid is typically prescribed in cases of pemphigus / pemphigoid?
prednisolone
Which type of hypersensitivity reaction is pemphigus / pemphigoid?
Type II
Which immunology tests are done for immunobullous diseases?
Immunofluoresence and Biopsy
What is the key difference between bullous pemphigoid and MMP?
There is no scarring in bullous pemphigoid.
Which immunobullous disease causes oral blistering that may appear in groups known as rosettes?
linear IgA disease
Patient attends with bleeding, crusted and ulcerated lips and mucosa. They also have round, red lesions on their skin (target lesions).
a - name of condition
b - name of the major form of this condition
a - erythema multiforme
b - stevens- johnson syndrome
Which group of antibiotics can cause erythema multiforme?
sulphonamides
Patient presents with white patch on hard palate. Smokes 5 a day for 10 years.
a - name of condition
b - cause of red dots
c - tx
a - nicotine stomatitis
b - inflammation of ducts of minor salivary glands
c - smoking cessation
Patient presents with white patch on buccal mucosa - large occlusal amalgam on UR8.
a - what is the condition
b - differential diagnosis and how can it be ruled out
c - tx
a - lichenoid reaction
b - lichen planus (but this is bilateral and symmetrical so can be ruled out)
c - removal of amalgam
Which type of hypersensitivity reaction is a lichenoid reaction?
Type IV
Which 2 antihypertensives can cause lichenoid drug reactions?
ACE inhibitors
beta-blockers
Patient presents with bilateral and symmetrical white patches on labial and buccal mucosa.
a - what is the condition
b - cells impacted?
c - questions asked to confirm diagnosis
d - treatment if symptomatic
a - lichen planus
b - impacts basal keratinocytes by t-lymphocytes
c - any lesions anywhere else
d - betamethasone to relieve inflammation and pain, difflam and SLS free toothpaste
Lichen planus impacts which type of epithelium?
stratified squamous epithelium
Pt presents with sore red gums that are present across the whole of the mouth.
What is the condition known as and what is it a variant of?
Desquamative Gingivitis -
variant of OLP.
Which demographic of pts is most susceptible to lichen planus?
middle aged / elderly women
Which autoimmune connective tissue disease can cause unilateral white lesions in the mouth, less defined than OLP?
Lupus Erythematous
What is the name given to the skin lesion of Lupus Erythematous?
Butterfly Rash
Which type of hypersensitivity reaction is lupus erythematous?
Type III (immune complex mediated reaction)
Which condition would you expect to see in a pt who is a betel nut chewer?
Submucosal Fibrosis
(urgent referral)
Which drug causes folate deficiency?
methotrexate -
inhibits dihydrofolate reductase (crucial in folate metabolism) so end products for DNA synthesis can’t be made.
What are the 3 main manifestations of iron, B12 and folate deficiencies?
- angular chelitis
- RAS
- glossitis
Schilling’s test detects which deficiency?
Vitamin B12
Pt presents with painless red patch and informs you that unusual lesions have appeared on skin and genitals.
a - diagnosis
b - management
SCC - urgent 2 week referral
Pt presents with purpura on soft palate and tonsils. They’ve felt unwell and weak for weeks, which illness do you suspect?
Glandular Fever - HHV4 Epstein-Barr Virus
(would also expect to see hairy leukoplakia)
Epstein-Barr Virus is associated with which type of non-hodgkin lymphoma?
Burkett Lymphoma
Pt presents with several recurring ulcers that appear in the posterior part of the mouth and heal within 3 weeks with scarring. IO you see ulcers >10mm in size.
What is this condition?
Major RAS
Pt presents with recurring ulcers occurring anteriorly and heal within 3 weeks - normally 2-3 present and IO you see several small ulcers on the labial mucosa approx 3mm in diameter.
What condition is this?
Minor RAS
Pt presents with many small ulcers on labial mucosa that normally heal within 3 weeks. Ulcers are 2-3mm in size.
What condition is this?
Herpetiform RAS
7 year old presents with painful inflamed gingiva, labial mucosa, tongue and throat.
What is this condition and what causes it?
Primary Herpetic Gingivostomatitis -
caused by herpes simplex virus.
In which 3 instances would tetracyclines be contraindicated?
- pregnant and breastfeeding
- under 12 years old
- liver disease
Disease involving intolerance that can cause apthous like ulcers.
Which disease is this and what issues can it cause with tooth development?
Coeliac Disease -
causes enamel hypoplasia and delayed eruption.
Pt presents with lip swelling, RAS like ulcers and soreness around corners of the lips.
What is your provisional diagnosis and what diet advice would you give?
Orofacial Granulomatosis -
advise cinnamon and benzoate free diet.
Which IBD can cause cobblestone appearance of mucosa?
Chron’s Disease
What is the name given to the ulcers which are a highly specific marker for ulcerative colitis?
pyostomatitis vegetans
Which blood test can be done to indicate abnormal levels of systemic inflammation?
(e.g: when differentiating between Chron’s and OFG)
C Reactive Protein (CRP)
Pt presents with minor apthous ulcers that are painful and are similar on skin and genitals. Their eyes have become more red since the last appointment.
Which disease would you suspect?
Behçet’s Disease
- blood vessel inflammation (think mum’s eye)
A cancer patient receiving radiotherapy complains of soreness and taste changes. IO you see atrophy / ulceration.
What is this condition?
Radiotherapy-Induced Mucositis
Pt complains of sore, red gums. IO you see ulceration around the interdental papillae and halitosis.
What is this condition?
ANUG
Which pathogen causes ANUG?
pyogenes intermedia
What antibiotic should be prescribed for patients suffering with ANUG?
400mg of metronidazole taken 3x daily for 3 days
How should the prescription differ for patients taking warfarin and why?
Pts on Warfarin = 500 mg amoxicillin 3x daily for 3 days.
(metronidazole causes warfarin to be broken down more slowly)
Pt complains of a painful ulcerated area on the palate - they are a pipe smoker.
What condition is this?
Necrotising Sialometaplasia - necrosis of minor salivary glands.
How would you manage Necrotising Sialometaplasia?
- Biopsy (can resemble SCC)
- smoking cessation
- chlorhexidine use
A pt with angina presents with an ulcer on the dorsum of their tongue.
What is the most likely cause of this?
The pt takes nicorandil for their angina.
Which 2 types of OLP would you request a biopsy for?
- erosive
- atrophic
- bullous
(done to rule out underlying anaemia or haematinic deficiency)
Which antibiotic can cause oral pigmentation?
tetracyclines
Pt comes in presenting with dark cutaneous freckles on their buccal mucosa, lips and certain areas of their skin. FH of cancerous intestinal polyps.
Which condition is this likely to be?
Peutz - Jegher’s Syndrome
Which disease is characterised by hypocortisolism (not enough cortisol) and can cause hyperpigmentation on gingiva and mucosa?
Addison’s Disease -
think lack of cortisol.
Which 2 drugs contraindicate the prescription of fluconazole and miconazole?
- warfarin
- statins - use nystatin instead
Which candidal infection has the potential to turn malignant?
Chronic Hyperplastic Candidosis
Chlorhexidine inactivates which drug used to treat candidal infection?
Nystatin
A pregnant pt presents with a large, solid swelling on the gums.
What is this likely to be?
Pregnancy Epulis -
benign tumour which develops on gums during pregnancy (associated with hormonal changes and increased blood flow).
How would you manage a Pregnancy Epulis?
OHI and PMPR
Which type of cell does HPV exclusively replicate in?
keratinocytes
Pt presents with a large, soft, yellow swelling on the buccal mucosa.
What is this likely to be?
lipoma
Which antibiotic can be prescribed for bacterial sialadenitis?
FLucloxacillin
Pt presents with large swelling on the RHS of their face.
IO there is a blue-ish appearance, they tell you it appeared a year ago and has grown slowly in size. No associated pain.
What is this condition and in which group of patients is this most prevalent in?
Pleomorphic Adenoma -
most prevalent in Scottish women.
Which rheumatoid arthritis drug causes gingival hyperplasia?
ciclosporin
Which calcium channel blocker causes gingival hyperplasia?
amlodipine
2 conditions caused by Coxsackie A?
- herpangina
- hand, foot and mouth disease
Pt presents with lesions around the mouth and vesicles which rupture IO. They also tell you they feel unwell, feverish, malaise, cough, sore mouth and abdominal pain.
Which condition is this likely to be?
Hand, foot and mouth.
Patients taking metronidazole should be advised to avoid what?
alcohol (and not be pregnant)
Which type of cyst is commonly associated with PE wisdom teeth and results in a buccal swelling?
paradental cyst
What is a dentigerous cyst?
A cyst around the crown of an unerupted or impacted tooth.
What is an eruption cyst?
Similar to dentigerous cyst but found around an erupting tooth in the soft tissue.
Radiolucency seen below the ID canal radiographically:
Stafne’s bone cavity
Salivary flow rate considered to be dry mouth:
0.5ml/min
Which 2 autoimmune disorders affecting connective tissue can cause secondary sjögren’s syndrome?
- Systemic Lupus Eythematous
- RA
When extracting a tooth with Ehlers Danlos Syndrome, why should pressure be applied to the socket and be sutured after?
Because EDS affects haemostasis.
Which life threatening condition has symptoms of fatty liver disease and encephalopathy?
Reye’s Syndrome -
associated with chickenpox and aspirin in children
When is a patient considered a high MRONJ risk?
When they have been taking bisphosphonates (oral or IV) for over 5 years,
Which common analgesic can cause a chemical burn?
aspirin
Pt presents with multiple macules on the labial mucosa and gingiva. They tell you they have been experiencing weight loss, vomiting and weakness.
Which condition would you suspect?
Addisons Disease
Which disease is commonly associated with pyostomatitis vegetans?
IBS
Which systemic condition can be caused by vitamin D deficiency due to CKD, can cause bony tumours in the mandible (Brown’s Tumours) and have oral manifestations including the loss of lamina dura?
hyperparathyroidism
Which genetic bony condition causing pigmentation presents with the ‘cafe au lait’ lesion?
albright’s syndrome
Which pulmonary disease can cause the oral manifestation of yellow blistering?
Sarcoidosis -
causes granuloma formation throughout the body.
Which virus is associated with Bell’s palsy and what is the characteristic facial sign?
Herpes Simplex Virus -
temporary weakness or lack of movement affecting one side of the face.
Is metronidazole bacteria static or bactericidal?
Bacteriostatic -
inhibits the growth of bacteria by inhibiting with protein synthesis, DNA replication or metabolic pathways.
Does metronidazole impact aerobic or anaerobic bacteria?
Anaerobic
Why do pregnancy epulis’ occur?
As an increased inflammatory response to plaque during pregnancy.
Are blood tests neccessary for OLP?
Only for atrophic, erosive or bullous lesions to rule out any underlying anaemia / haematinic deficiencies.
Lichenoid Drug Interactions
- antihypertensives (ACE inhibitors!!)
- NSAIDs
- oral hypoglycaemics
- gold salts
- antimalarials
- carbamazepine
Which feature on a biopsy tested with direct immunofluorescence would make you consider mucous membrane pemphigoid?
The antibody distributed in a linear fashion along the basement membrane zone.
